Dr. Charu Mithal's principal speciality. Fellowship-trained at LV Prasad Eye Institute Hyderabad and Dr. R.P. Centre AIIMS, she treats diabetic retinopathy, retinal detachment, macular hole and age-related macular degeneration with imaging-led decisions and micro-incision surgery.
The retina is the thin, light-sensitive layer at the back of the eye that turns light into the signals your brain reads as vision. At its centre is the macula — a patch a few millimetres across that carries all of your detailed central sight, the vision you use for reading, faces and driving. When the macula is damaged, glasses cannot help, because the problem is not focus but the sensor itself.
Retinal disease behaves differently from the rest of ophthalmology in one important way: much of it is painless and silent until it is advanced. Diabetic retinopathy can be well established while vision still reads 6/6 on the chart. A retinal tear can be repairable with a fifteen-minute laser on Monday and require major surgery by Friday. The window in which treatment is easy and cheap is often the window in which the patient feels perfectly fine.
This is also the most technology-dependent part of eye care. Optical coherence tomography shows the retinal layers in cross-section at near-histological resolution; fundus fluorescein angiography maps where blood vessels are leaking or closed; B-scan ultrasound sees through a bleed. Decisions made without these images are guesses.
Dr. Mithal completed a vitreo-retinal fellowship at LV Prasad Eye Institute in Hyderabad, one of the world's leading centres for retinal disease, with further training at Dr. R.P. Centre, AIIMS and Mid Yorkshire NHS Trust in the United Kingdom. Retina is what she does — not an add-on to a general practice.
Some of these warrant a same-day examination. If you notice a sudden change, do not wait for a convenient appointment slot.
Damage to retinal blood vessels from long-standing diabetes — the leading cause of working-age blindness in India. Ranges from mild non-proliferative changes needing only monitoring, through diabetic macular oedema requiring anti-VEGF injections, to proliferative disease needing pan-retinal photocoagulation or vitrectomy for bleeding.
The retina separates from the wall of the eye. An emergency: the longer the macula stays detached, the less vision returns even after perfect surgery. Repaired by vitrectomy with gas or silicone oil tamponade, or by scleral buckling in selected cases.
Often the stage before detachment, announcing itself as new floaters and flashes. If caught in time, a barrier laser performed in the clinic in fifteen minutes may prevent an operation entirely.
Degeneration of the central macula after age 55. The dry form is managed with monitoring, Amsler grid self-testing and antioxidant supplements; the wet form, driven by abnormal new vessels, is treated with intravitreal anti-VEGF injections that can preserve and often improve vision.
A full-thickness break at the fovea, or a fine scar tissue sheet wrinkling the macula. Both cause central distortion and are treated by vitrectomy with membrane peeling, with good closure rates when operated in reasonable time.
A blocked retinal vein causing sudden painless vision loss and macular swelling. Managed with anti-VEGF or steroid injections and laser, alongside investigation of the underlying blood pressure, cholesterol or clotting problem.
Fluid collecting under the macula, classically in stressed men in their thirties and forties. Many resolve spontaneously; persistent cases are treated with laser or photodynamic therapy.
Bleeding into the vitreous gel that blocks vision entirely. B-scan ultrasound assesses the retina underneath and determines whether to observe or proceed to vitrectomy.
Abnormal retinal vessel growth in premature babies. Screening is time-critical — treatment windows are measured in days, not weeks.
Retinal management follows a consistent pathway: image first, then decide. Nothing is proposed on impression alone.
Drops widen the pupil so the entire retina, right out to the periphery, can be examined with indirect ophthalmoscopy and a slit-lamp lens. Vision stays blurred for three to four hours afterwards, so bring someone with you.
A non-contact scan producing a cross-section of the retinal layers. It quantifies macular swelling to the micron, identifies a hole or membrane, and is repeated at each visit to measure whether treatment is actually working.
Wide-field colour photographs document the retina for comparison over time. Fluorescein angiography traces dye through the retinal circulation to reveal leaking or closed vessels invisible on examination.
When a dense cataract or vitreous bleed blocks the view, ultrasound shows whether the retina beneath is attached — often the deciding factor on whether to operate urgently.
Anti-VEGF or steroid delivered directly into the vitreous under sterile conditions with topical anaesthesia. Takes a few minutes and is usually painless. A course of three loading doses is typical, then treatment guided by repeat OCT.
Barrier laser seals a tear before it can detach. Pan-retinal photocoagulation reduces the drive for abnormal vessel growth in proliferative diabetic retinopathy. Both are outpatient procedures.
Micro-incision 25G or 27G vitrectomy removes the vitreous gel through ports under a millimetre wide, allowing the surgeon to peel membranes, close a macular hole, reattach a retina or clear blood. Usually sutureless, often as day-care.
Retinal disease is managed over years, not visits. You will be given a defined review interval and a repeat OCT schedule so that changes are caught while they are still easily treatable.
Recovery varies enormously with the procedure. An intravitreal injection means a scratchy eye for a day and no restrictions to speak of. A vitrectomy for retinal detachment or macular hole is a bigger undertaking, and if a gas bubble has been used, face-down positioning may be required for several days — demanding, but decisive for the outcome.
Vision after retinal surgery improves gradually over weeks to months rather than overnight, and the ceiling is set by how much healthy retina remains. This is exactly why early presentation matters so much.
Retinal treatment costs depend on the drug used, the complexity of surgery and whether tamponade agents are needed. Indicative ranges for Delhi NCR:
Indicative ranges for Delhi NCR as a guide only. Your written estimate is given after examination and depends on the technology, lens or drug used, hospital tariff and insurance cover. Most procedures are supported by cashless insurance at Max hospitals.
Retina, cataract, glaucoma and LASIK evaluations at Max Smart Saket, Max Panchsheel Park and Synergy Eye Care.
